Healthcare Provider Details

I. General information

NPI: 1982605507
Provider Name (Legal Business Name): CANTON CHRISTIAN HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 CLEVELAND AVE NW
CANTON OH
44709-3306
US

IV. Provider business mailing address

2550 CLEVELAND AVE NW
CANTON OH
44709-3306
US

V. Phone/Fax

Practice location:
  • Phone: 330-456-0004
  • Fax: 330-452-9951
Mailing address:
  • Phone: 330-456-0004
  • Fax: 330-452-9951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1618N
License Number StateOH

VIII. Authorized Official

Name: MR. THOMAS STROBL
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-456-0004